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Expert Concussion Group Backs Rugby Approach

Independent neurologists, rugby medics and the players union have given their unanimous backing to the IRB's Pitchside Suspected Concussion Assessment (PSCA) protocol, recommending the continuation of the current global trial in elite rugby.

The concussion management working group unanimously agreed that the trial should be extended for another 12 months as it is working, benefiting the game and mitigating the risk of mismanagement of concussion in rugby.

Under the trial there has been a 25% increase in players being permanently removed from the field of play following a head impact.

The recommendation follows the scheduled year-one review of data from over 180 examples of head injury management from matches under the trial and included feedback from team doctors implementing the protocols.

IRB Chairman Bernard Lapasset said: "The IRB and its member Unions consider this area of player welfare to be paramount in rugby and welcome the results of this review of the outcomes from the first year of the Pitchside Suspected Concussion Assessment global trial."

The PSCA was developed as a supportive welfare tool by a specialist independent working group and is designed to give teams and match doctors time to assess cases in which concussion is not immediately apparent. Previously, players were being left on the field if it was unclear if a player was concussed.

The IRB has also moved to address recent misconceptions regarding the rugby concussion management approach following recent high profile cases in Test rugby.

"The IRB would like to reiterate that the PSCA process was developed in line with industry best practice to support the team doctors in assessing head injuries. It has not been developed to allow time for medics to look for reasons to clear a concussed player.

"The message to doctors and players is: if a player is clearly concussed then that player should be removed permanently, and there is no need for the PSCA."

The IRB is a signatory to the 2012 Zurich Consensus statement on concussion, widely recognised as the world's leading sports concussion forum.

The statement confirms that athletes should not be allowed to return to play after a diagnosed concussion and should not return to play or train on the same day and goes on to outline an approach to help physicians determine when an athlete might be safe to return to sport.

The IRB's approach under the guidance of the IRB Medical Commission, featuring top sports physicians and independent experts, is entirely consistent with Zurich.

The commission has driven key revisions to IRB Regulation 10, including concussion management and return to play protocol guidelines and importantly education best-practice for elite and community rugby.

Dr. Raftery added: "The IRB and its Unions continue to take a proactive and protective approach to the management of suspected concussion as there is no perfect diagnostic test or marker in medicine that doctors can rely on for an immediate diagnosis. The IRB will continue to support further research initiatives in this important area."

IRB Regulation 10 features a two-pronged approach to protect players at both the elite and community levels. Where concussion is diagnosed, a player must be removed from the field of play and not return to play or train on the same day and must be guided through a dedicated return to play protocol.

All players with suspected concussion where there is no appropriately qualified person present to diagnose concussion must be removed from the field of play and not return to play or train on the same day and should be reviewed by an appropriately qualified person and then should complete the graduated return to play protocol described in the IRB Concussion Guidelines.

The IRB concussion protocols, under IRB Regulation 10 and outlined at www.irbplayerwelfare.com, cover approaches for the community and elite game.

The graduated return to play protocols within Regulation 10 are recommended by the Zurich Consensus Group. The previous mandatory three-week rule have been shown to have poor compliance and no provide improvement in player welfare.

The PSCA was developed by an independent expert group including a neurologist and an expert with a PhD in Concussion to standardize the procedure of assessment of head injuries where concussion is suspected, but unclear.

Previously doctors were required to assess players on the field and the run, which potentially endangered the welfare of those players. The PSCA was not operational during the 2013 RBS 6 Nations.

Rugby acknowledges the relevance of research into the long-term effects of repeated blows to the head, particularly CTE and is being proactive.

Currently, there is no scientific link between a single or even two concussion and long-term brain injury, but the IRB has been proactive in launching a long-term study in 2012 with the University of Auckland.